Health Care Reform in a New Political Environment: Predicting the Shape of Change

Abstract

This article posits that the adoption of single-payer health insurance is effectively impossible in the United States. In spite of evidence that a single-payer system might be substantially more efficient and inexpensive than the complex, administratively-burdened multi-payer system we currently have, the probability that it can be part of health care reform is remote at best. The article identifies a number of reasons that a single-payer health insurance system cannot succeed ranging from inertia, path dependence, the expense of the Medicare program, the American belief in looking to the private sector for solutions to even large social problems, the fear of big government coupled with the belief that government is the problem rather than the solution, the political preference for incrementalism over fundamental change, and cultural beliefs such as the belief that while all Americans enjoy equality of opportunity, only those able to capitalize on the opportunity are entitled to enjoy its fruits.

Keywords: health care reform, universal access to health care, single-payer, American preferences

JEL Classification: A13, D30, D63, H51, I18, L33, Z10